Herpes simplex and varicella zoster CNS infections: clinical presentations, treatments and outcomes
Abstract
Objectives To describe the clinical manifestations, cerebrospinal fluid (CSF) characteristics, imaging studies and prognostic factors of adverse clinical outcomes (ACO) among adults with herpes simplex virus (HSV) or varicella zoster virus (VZV) CNS infections.Methods Retrospective review of adult patients with positive HSV or VZV polymerase chain reaction on CSF from an observational study of meningitis or encephalitis in Houston, TX (2004-2014), and New Orleans, LA (1999-2008).Results Ninety-eight adults patients were identified; 25 had encephalitis [20 (20.4 %) HSV, 5 (5.1 %) VZV], and 73 had meningitis [60 (61.1 %) HSV and 13 (13.3 %) VZV]. HSV and VZV had similar presentations except for nausea (P < 0.01) and rash (P < 0.001). The CSF profile did not differ between HSV and VZV infection. Abnormal neuroimaging findings were found in 11.6 % (10/86) brain CTs and 21.3 % (16/75) brain MRIs. The EEG was abnormal in 57.9 % (11/19). Sixteen patients (16.3 %) had an ACO (10 HSV encephalitis, 3 VZV encephalitis and 3 VZV meningitis). Intravenous acyclovir administered within 48 h was protective against an ACO [OR 0.19 (0.04-0.80), P = 0.02). However, on logistic regression only Charlson comorbidity score >1 and an encephalitis presentation were independently associated with an ACO. The treatment for HSV meningitis was variable, and all patients had a good clinical outcome.Conclusion Alpha herpes CNS infections due to HSV and VZV infections have similar clinical and laboratory manifestations. ACO was observed more frequently in those patients with comorbidities and an encephalitis presentation.
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Studies assessing prognosis using hard endpoints in the post-acyclovir era showed neurological impairment in 20-60% of VZV patients upon hospital discharge, 55% after one month, 51% after three months, and 71% after one year after the acute episode.
“Studies assessing prognosis using hard endpoints in the post-acyclovir era showed neurological impairment in 20–60% of patients upon hospital discharge [62–64], 55% after one month, 51% after three months and 71% after one year [62, 65] after the acute episode.”
From Cognitive decline following acute viral infections: literature review and projections for post-COVID-19 (2022) · cites this paper as [63]
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- Authors
- Kaewpoowat, Q., Salazar, L., Aguilera, E., Wootton, S. H., & Hasbun, R.
- Affiliations
- The University of Texas Health Science Center at Houston (US)
- Corresponding author
- Kaewpoowat, Quanhathai
- Venue
- Infection
- Published
- 2015-12-17
- Volume
- 44
- Issue
- 3
- Pages
- 337-345
- ISSN
- 0300-8126 (ISSN-L)
- 1439-0973
- OpenAlex
- W2216932999
- Cited by
- 109
- References
- 42
- Citations by year
- 2026: 2 · 2025: 16 · 2024: 6 · 2023: 9 · 2022: 12 · 2021: 9 · 2020: 8 · 2019: 11 · 2018: 12 · 2017: 14 · 2016: 9
- FWCI
- 9.16
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Infection (publishedVersion)
- PubMed (publishedVersion)
- Funders
- Grant A Starr Foundation
- National Center for Research Resources (NIH-1 K23 RR018929-01A2)
- Topics
- Health Sciences › Medicine › Epidemiology › Herpesvirus Infections and Treatments
- Health Sciences › Medicine › Infectious Diseases › Infectious Encephalopathies and Encephalitis
- Health Sciences › Medicine › Epidemiology › Cytomegalovirus and herpesvirus research
- Keywords
- herpes simplex virus, varicella-zoster virus, herpes simplex encephalitis, adverse clinical outcomes, acyclovir, intravenous antiviral therapy, neuroimaging findings, EEG abnormalities, Charlson Comorbidity Index, prognostic factors, adults
- MeSH terms
- Adolescent, Adult, Aged, Aged, 80 and over, Female, Humans, Male, Meningitis, Viral, Middle Aged, Retrospective Studies, Herpesvirus 3, Human, Treatment Outcome, Simplexvirus, Encephalitis, Herpes Simplex, Young Adult
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